HIV in children is not an individual disease but a disease that affects the entire family. With the advent of antiretroviral therapy (HAART), pediatric HIV has evolved from a rapidly progressive fatal disease to a chronic infection with prolonged survival. Being a chronic disease, it affects the overall lifestyle, physical and even social functioning. With fear of AIDS (acquired immune deficiency syndrome) and social stigmatization; families live in fear, grief, guilt and depression.

Due to misconceptions about transmission and mode of inheritance by the general public and even medical staff, patients who are HIV positive are almost discriminated and treated as untouchables. This attitude is depressing, misconceptual and almost suicidal for the patients. Hence it’s very important to understand correct mode of transmission, precautions while handling biological wastes of HIV positive children and how to enable these children to be a part of society.

• Mode of transmission:
  
  
• HIV virus is not transmitted through everyday contact. It is not transmitted through sneezing, coughing, hugging, touching or sharing food.



• HIV is a lymphotrophic virus and is transmitted on contact to body fluids such as blood, pleural fluid, pericardial fluid, CSF fluids and seminal secretions only if there is breach of the mucous membranes and skin. It is not transmitted through saliva, urine or stools until and unless the child has bleeding in these sites.
  
  
• Infected breast milk is another source of transmission in infants.



• Waste disposal of an HIV positive child


• Changing diapers
• While changing diapers of an HIV positive child, it is preferable to wash hands with soap and water before and after changing a diaper. Disposable gloves should be used if there is blood in the stool or urine, and if the caretaker has a rash or open cut on the hands. Disposable diapers should be placed in a leak –proof plastic bag and put in the trashcan. Reusable or washable nappies should be washed separately and presoaked with detergent heavily. Bleach should be added to the soiled clothes to inactivate the virus.
  
  
• Washing clothes Clothes of an HIV positive child can be washed with everyone else’s clothes. However, if the clothing is soiled by blood, semen, urine, feces or vomit, it should be washed separately with addition of bleach to inactivate the virus.
  
  
• Body fluid spills– In case of spilling of blood, urine, vomit, stools, bloody saliva of an HIV +ve child, the spills should be cleaned wearing disposable gloves and wiped with disposable rags or paper towels. The surface should be cleaned with a bleach solution (1/4 cup bleach to 2.5 litres of water). The surface should be washed and air-dried. The disposable gloves, rags should be placed in a leak-proof plastic bag and put in the trashcan.
  
• Meal times- No eating restrictions are needed for an HIV positive child. The child can eat together with everyone and can be served from a common serving dish. The child should use the same dishes, glasses, spoons & forks every time. The dishes and utensils need not be washed separately. All dishes should be washed in hot, soapy water.
• Sharing toys-Toys can be shared as normal as sharing toys does not transmit HIV. However if a child who is HIV positive has put a toy in his/her mouth, the toy should be thoroughly washed in soap and water before another child plays with it.
• Injuries and Accidents-HIV transmission due to accidents and injuries may occur only if –



• There is a bleeding wound or exudative skin lesion in HIV infected child.
  
  
• Presence in a susceptible child of a skin lesion or exposed mucous membrane that could serve as a portal for systemic entry of the virus.
  
  
• Sustained contact between the portal of entry of the susceptible child and infective material.
  
  Thus fresh blood to blood transmission is extremely rare.
  
  
In case of cuts and sores in an HIV +ve child, the area should be washed immediately with soap and water. Caretaker should wear disposable gloves and clean the blood spills as discussed earlier. The wound should be immediately cleaned with an antiseptic and closed dressing with gauze and bandage should be done. Waste should be disposed in a leak- proof plastic bag. Tetanus toxoid and tetanus immune globulin may be administered if vaccination of the child is incomplete.


• Sharing information -Parents are not obligated to tell school authorities or friends about the child’s HIV status if they fear discrimination. However, universal precautions have to be advocated.
  
  Disclosure to the children of the nature of their illness is essential. Information given should be according to the child’s development level to ensure child’s acceptance of the disease and he/she should follow the precautions to prevent spread to others.
  
  Thus it is important for caretakers to develop heath policies that include universal precautions and proper hygiene for all children. These precautions decrease the risk of transmission of not only HIV but also other infections. Infact the risk for other infections is far greater than that of HIV virus.